There are several reasons why a woman may have a caesarean section. A planned section may be scheduled because of the position or health of the baby, the mother’s medical history or at her request if she has had a previous, traumatic vaginal birth. An emergency section usually occurs because complications have arisen during natural labour. A ceasarean section is a major operation that requires incisions through the abdomen and uterus and so the significant recovery period is well accepted by medical professionals and society in general. However, the emotional after effects of this type of birth remain less acknowledged and far less discussed. The silence and stigma surrounding mental health after a c-section can be detrimental to new mothers who’ve not only just been through major surgery, but now have a newborn baby to care for too. Here are just a few of the emotional issues that may arise following a c-section.

Shock

It’s extremely common for the body to go into shock immediately after the surgery is carried out. Many women report shaking from head to toe as medication from the epidural and affect the muscles. But further on into the recovery process many women experience delayed shock, especially when the c-section was carried out in emergency circumstances. They spend so long preparing for their labour, writing birth plans and building up expectations so when things don’t go to plan it can be a huge surprise. Using a debriefing service following a c-section can be a good way to come to terms with the experience and understand why it had to happen.

Guilt

A study carried out by Channel Mum found that one in five mothers said that opting for a ceasarean would mean that they’d ‘failed’ and with that sense of failure undoubtedly follows feelings of guilt. Outdated social views can lead to women believing that a drug-free, natural labour is the most honourable way to give birth. Some women even report that having a caesarean has made them to feel like less of a woman and less of a mother. Of course this is untrue and all that really matters in labour is that mother and baby both come through the process safely.

Post natal depression

Although all women who go through childbirth are at risk from postnatal depression, studies show that women who have an emergency caesarean are up to six times more likely to suffer from the condition. The longer recovery period and feelings of guilt, failure and lack of control over their own body are all thought to contribute to this, alongside the hormonal changes that all new mums face. It’ is important to speak to a health visitor or GP if you think you could be suffering from postnatal depression. Self help advice, medication and therapy can all help to alleviate the symptoms.

Trouble bonding

Some women report that they have struggled to bond with their babies following a caesarean section. There are several theories for this. Biologically, research indicates that they miss out on the release of the hormone oxytocin (otherwise known as the love hormone). Immediately after natural childbirth the release of this hormone is higher than ever and missing out it can impair the initial bonding process. In addition to this, skin to skin contact (vital for developing early closeness and bonding) is rarely possible straight after a c-section and in many cases the baby is taken away and checked over while the mother recovers. On a more practical level, the long recovery process can sometimes render a new mum unable to carry out day to day care of the child which can make her feel disengaged from her new baby.

Fear of future pregnancy

Sometimes all of these factors combined, along with the physical pain of a c-section, can make women so fearful of a repeat performance that they choose not to become pregnant again. Of course this can be a devastating choice for a woman who really wants another baby. After a c-section, the probability of a natural birth next time is good – research indicates 60-80% of women can potentially go on to have a vaginal birth after a ceasarean (VBAC). But there are risks and these, alongside the fear of another c-section, can be enough to put some women off for life. If you feel like this but still long to expand your family it is important to talk to your GP or debriefing service to familiarise yourself with all of the facts so that you can make an informed choice.

“The condition of having a developing embryo or fetus in the body.”
“The process by which a human female carries a live offspring from conception until childbirth.”

Pregnancy is referred to as a gestation period – the time between conception and birth. Approximately 40 weeks (280 days). Measured from the first day of the last menstrual period. For women who use a procedure that allows them to know the exact date of conception (such as in-vitro fertilisation IVF, or artificial insemination) the gestation period is 38 weeks (266 days) from conception.

Pregnancy is divided into three stages – called trimesters, each lasting about 3 months.

An embryo is a multicellular diploid (has two sets of chromosomes) eukaryote (an organism whose cells contain complex structures enclosed within membranes) in its earliest stage of development; from the time of first cell division until birth. In humans, it is called an embryo until about eight weeks after fertilization (i.e. ten weeks after the last menstrual period or LMP), and from then it is instead called a fetus.
Embryo is the term used to describe the developing baby in the first 8 weeks and the term Fetus is the term used after 8 weeks until birth (when all the structure of the baby and systems of the body such as the digestive and nervous systems have developed).

Facts at 24 weeks
24 weeks is the legal cut off gestational age for a legal abortion (although abortions or terminations can be carried out later in the pregnancy on medical grounds).

COMPLICATIONS OF PREMATURE BIRTH
Babies born after 34 weeks have a low risk of problems although they are sometime slower to feed.
A baby born before 33 weeks will have more serious problems such as immature lungs.
Very premature babies (born under 28 weeks) need to be delivered in a hospital with a neonatal intensive care unit.
Doctors have been able to improve dramatically the survival hopes for babies born as early as 22 or 23 weeks.
However, very premature babies face a huge battle at the start of life. They are at risk of serious conditions including:
* Hypothermia, due to lower levels of fat
* Low blood glucose, which can lead to brain damage
* Respiratory distress syndrome – which can cause blindness
* Brain haemorrhage
Long-term they may have cerebral palsy and have sight and hearing problems.
They are also more likely to have motor impairments and co-ordination and concentration problems.

Birth
Occurs at around 38 weeks after fertilization, so 40 weeks pregnant. Term is considered to be 37 – 42 weeks gestation. The fetus has developed enough to survive easily outside its mother’s body. Babies are usually born head first but occasionally are born breech.

Following the recent screening of “Freedom for Birth” a film documentary discussing the plight of maternity services and midwifery world-wide I have put together an Action Plan of ideas that you may like to consider to support the midwives and maternity services. Please do as much as you can to make things better for women today and our daughters in the future.

On Thursday 20th September women (and men) around the world will be hosting film screenings to raise the profile of midwifery. I am joining this event because I passionately believe that women are entitled to better maternity care.

Everyone in the UK knows that our maternity services are in crisis and indeed the Royal College of Midwives has strongly stated this.

I am planning to take a break from midwifery as I am totally burnt out … this is partly the demands of being on-call 24/7 for the past 8 years, but it is also due to the increasing scrutiny, red tape and pressures on midwives. I believe that most midwives do their very best for women. Of course there are some rouge practitioners and the public needs to be protected against them, but the pressures on midwives are immense; more paperwork, more investigations of our practice, pressures of working with a system that is barely fit for purpose ….

At the same time Independent Midwifery, which gives “gold standard” care is set to become illegal unless an eleventh hour solution can be found to provide us with Professional Indemnity Insurance which will become mandatory from October 2013.

What will happen to these highly skilled midwives and the clients they currently care for? I’m afraid that I feel ground down and beaten by all that is currently happening in midwifery … it is so sad, midwifery and childbirth has been my passion and my life for the past 20 years!

So, as my swan song to midwifery (for now at least) I am hosting this film showing in Milton Keynes and I hope this will serve to raise the profile of midwifery and to mobilise women to demand the service they deserve.

FREEDOM FOR BIRTH FILM SCREENING Thursday 20th September 2012 Two showings, 1pm and 7pm

FREEDOM FOR BIRTH – GLOBAL FILM LAUNCHA new documentary that reframes childbirth as the most pressing global Human Rights issue today is launching with hundreds of premieres all over the world on the same day, Thursday 20th September 2012.

Freedom For Birth is a 60 minute campaigning documentary featuring a Who’s Who of leading birth experts and international Human Rights lawyers all calling for radical change to the world’s maternity systems.

Hermine Hayes-Klein, US lawyer and organiser of the recent Human Rights in Childbirth Conference at the Hague, the Netherlands says, “the way that childbirth is being managed in many countries around the world is deeply problematic. Millions of pregnant women are pushed into hospitals, pushed onto their back and cut open. They are subject to unnecessary pharmaceutical and surgical interventions that their care providers openly admit to imposing on them for reasons of finance and convenience. Women around the world are waking up to the fact that childbirth doesn’t have to be like this and it shouldn’t. Disrespect and abuse are not the necessary price of safety”.

Made by British filmmakers Toni Harman and Alex Wakeford, Freedom For Birth film tells the story of an Hungarian midwife Agnes Gereb who has been jailed for supporting women giving birth at home. One of the home birth mothers supported by Ms Gereb decided to take a stand.

When pregnant with her second child, Anna Ternovsky took her country to the European Court of Human Rights and won a landmark case that has major implications for childbirth around the world.

Toni Harman, one of the filmmakers says, “the Ternovsky vs Hungary ruling at the European Court of Human Rights in 2010 means that now in Europe, every birthing woman has the legal right to decide where and how she gives birth. And across the world, it means that if a woman feels like her Human Rights are being violated because her birth choices are not being fully supported, she could use the power of the law to protect those rights. With the release of “Freedom For Birth”, we hope millions of women become aware of their legal rights and so our film has the potential to spark a revolution in maternity care across the world. In fact, we are calling this the Mothers’ Revolution.”

Cathy Warwick, Chief Executive of the Royal College of Midwives (RCM), says: “A safe childbirth should be a fundamental human right for women. Sadly, for many, many millions of women and their babies across the world this is not the case. The world is desperately short of the people who can help to ensure and deliver this human right; midwives. There is a real need for leaders of nations to invest in midwifery care in their countries. I hope that the making of this film which the RCM is supporting with a screening will go a long way to help make skilled maternity care a reality for those women who currently do not have access to it.”

Lesley Page, President of the Royal College of Midwives adds, “Too many women across the world are dying or suffering terribly because of a lack of skilled maternity care. This is unacceptable and I call on all Governments across the world to give women the right and access to safe care in pregnancy and childbirth.”

Ms. Hayes-Klein concludes, “Freedom For Birth” holds the answer to changing the system. Birth will change when women realise they have a right to meaningful support for childbirth and claim that right. Birth will change when women stand up against the abuses that are currently suffered in such high numbers and say, No More.”

Freedom For Birth is Harman and Wakeford’s third documentary film about birth. They were inspired to make films about following their own difficult birth of their daughter four years ago. A cascade of interventions in their birth led to an emergency caesarean section.

Optimal Fetal Positioning (OFP) – Encouraging your baby into the best position for birth. How and why? (including quotes from local independent midwife Valerie Gommon)

The best position for birth is when the baby’s head is down and facing the mothers back and baby’s spine is to the left of your navel (known as left anterior/lateral position).

In this position the baby can pass most easily through the mothers pelvis. This will ensure a quicker and easier delivery.

Towards the end of pregnancy it is advisable not to slump back on the sofa as gravity will encourage your baby’s spine (the heaviest part of her body) to swing back towards yours! Instead, remember the good posture you have worked so hard to develop during your pregnancy yoga classes! This will gently tilt your pelvis forwards, as well as maximise the space your baby has to move around in. Whenever possible lean forwards to rest e.g over a yoga ball, table or legs wide over a backwards facing chair. As in our yoga classes, remember to use cushions to allow your hips to be level or higher than your knees when sitting. Use cat pose when ever you have a moment. Valerie also suggests: “getting onto your hands and knees to wash the kitchen floor or play with your toddler!” or just enjoy moving with your breath!

Another suggestion is that you “lie on your left side on the sofa with your belly hanging slightly over the edge – a nice relaxing way of encouraging your baby into the best position!” (Valerie Gommon).

However, do keep things in perspective if hoping to turn your baby…be comfortable, stay active and above all enjoy your pregnancy.

Remember babies can decide to turn right up to the last minute and some babies are just happy where they are whatever plans you might have for them!!

Very sadly it looks fairly certain that Independent Midwifery will end in October 2013. The Government and Nursing and Midwifery Council have for a long time been recommending that Independent Midwives should have professional indemnity insurance (negligence insurance) despite it not being commercially available in the marketplace i.e. insurers do not provide this insurance for midwives. You can read more about the current situation here http://www.independentmidwives.org.uk/?node=11615

An E.U. Directive is now due to come into force to implement this change and our current information is that it will be illegal for us to practice without professional indemnity insurance from October 2013. This means that women will be denied the choice of choosing an Independent Midwife and we will be denied the choice of working independently and will be forced to stop practising or to return into the NHS.

The Independent Midwives UK organisation has been working tirelessly for years to find a solution and it is just possible that an eleventh hour solution will be found but this is now looking unlikely.

A group of midwives have formed an organisation called Neighbourhood Midwives www.neighbourhoodmidwives.org.uk/ and are working towards setting up an employee-owned social enterprise organization, to provide an NHS commissioned caseload midwifery homebirth service, based in the local community. This may prove to be a workable alternative to Independent Midwifery but at present (if it comes to fruition) the service will only be able to accept “low-risk” women and this is of concern to all of us who have supported women with more complex situations, for example first time mothers, vaginal birth after a previous caesarean, twins, breech birth and women who are not deemed “low risk”. The aim of Neighbourhood Midwives will be to extend their remit to include more women as soon as possible.

There is already a precedent for this type of care as One to One Midwives in Liverpool www.onetoonemidwives.org have already managed to set up a caseloading midwifery service (similar to independent midwifery in that a woman will care for a caseload of women throughout the whole of the pregnancy, birth and postnatal period) within the NHS.

It is a very sad time for midwifery and for women’s choice, but perhaps good things will come out of it, I certainly hope so.

I was recently asked a question about painful stitches/perineum after childbirth and thought it would be useful to share my reply.

I’m not so sure you were told all this! You *should* have been, but sometimes things get missed in the busy hurly burly of hospitals!
Okay, so the pain … I take it this is when you wee? This may well have passed by now? This can be eased by weeing in the bath or shower or by pouring water from a bottle of jug over yourself as you pass urine. The pain gradually lessens but it should already have started to improve. If it is getting worse then you definitely need to get your midwife to check you out.

Don’t know whether you have opened your bowels yet, or if this is what you are referring too? Women are naturally worried about the first time after stitches. I usually suggest that if a woman is anxious that she might like to support the perineum (the stitched area) with some toilet paper when she goes to the loo. This is mostly a psychological prop, but … if it works … it will be fine I promise! Just make sure you drink plenty of fluids (this will also help dilute the urine) and eat so that you don’t get constipated.

Regarding the bleeding, it is normal to bleed for several weeks after having a baby. Again, the bleeding quickly lessens and will often stop only to start again … it is not unusual to bleed on and off for somewhere between 2 – 6 weeks after having a baby.

Your midwife will be very happy to have a look at your stitches and will usually ask you if you are comfortable or not. If you are unsure definitely ask her to look as occasionally they can become infected and need treatment.

Hope you soon feel more comfortable … in the meantime enjoy your new baby.